Employer Coverage Under an Employer Group Health Plan

Medicare

OMB: 3220-0082

IC ID: 186948

Information Collection (IC) Details

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Employer Coverage Under an Employer Group Health Plan
 
No Modified
 
Required to Obtain or Retain Benefits
 
42 CFR 406 42 CFR 407

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction RL-311-F (01-18) Evidence of Coverage Under an Employee Group Health Plan Form RL-311F (01-18).pdf No   Paper Only

Income Security General Retirement and Disability

RRB-20, Health Insurance and Supplementary Medical Insurance Enrollment and Premium Payment System (MEDICARE)  79 FR 58874

2,000 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 2,000 0 0 0 0 2,000
Annual IC Time Burden (Hours) 333 0 0 0 0 333
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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